This imaging was best at spotting disease progression in high-risk patients, study finds

CT scans of the chest may help detect disease progression in high-risk patients with head and neck cancer, say researchers in Taiwan.

They evaluated 270 screening chest CT scans conducted over 42 months in 192 patients with head and neck squamous cell carcinoma, which accounts for most head and neck cancers. The results were classified as either normal or abnormal.

Of the 270 scans, 79 (29.34 percent) were considered abnormal, including 54 (20 percent) that showed a malignant neoplasm of the lung and 25 (9.3 percent) that showed indeterminate abnormalities, said Dr. Yen-Bin Hsu, of Taipei Veterans General Hospital, and colleagues.

Patients most likely to have a malignant neoplasm of the lung included those with cancer classified as stage N2 or N3 (indicating some degree of lymph node involvement), those with stage IV disease (cancer has spread to another organ), and those who had recurrent disease or had a distant metastasis in another site.

"Indeterminate lesions were common on chest CT in our study, and special attention should be paid to them," the researchers wrote. "Based on the progressive changes in follow-up scans, 44 percent of indeterminate lesions were eventually considered a malignant neoplasm of the lung. We also found that small (less than 1 centimeter) solitary nodules, which were usually resectable [operable], carried significantly higher chances (66.7 percent) of being a malignant neoplasm."

"For patients with head and neck squamous cell carcinoma, chest diagnosis is crucial and may influence their treatment plan," they noted. "In conclusion, chest CT is recommended for high-risk patients, especially every six months for the first two years during the follow-up period, although its role is controversial for patients newly diagnosed as having head and neck squamous cell carcinoma. High-risk patients include those with N2 or N3 disease, stage IV disease or locoregional recurrence. For patients with indeterminate small [less than 1 centimeter] solitary pulmonary nodules, aggressive evaluation and management are imperative because of the high rate of a malignant neoplasm of the lung."

The study was published n the October issue of the Archives of Otolaryngology.